Stivarga (regorafenib) — United Healthcare

Initial criteria

• Diagnosis of soft tissue sarcoma
• One of the following: (a) Extremity/superficial trunk or head/neck that is non-adipocytic with advanced/metastatic disease with disseminated metastases OR (b) Retroperitoneal/intra-abdominal that is non-adipocytic with recurrent unresectable or stage IV disease OR (c) Advanced/metastatic pleomorphic rhabdomyosarcoma OR (d) Angiosarcoma

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Stivarga therapy

Approval duration

12 months